Organization
MADISON COMMUNITY HOSPITAL INC
Active
Other names
THE BEHAVIORAL CENTER OF MICHIGAN HOSPITAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN GUNABALAN (EXECT ADMIN)
(586) 261-2266
Entity
Organization
Contact information
Practice address
4050 E 12 MILE RD, WARREN, MI 48092-2534
(586) 261-2266
(586) 582-9570
Mailing address
4050 E 12 MILE RD, WARREN, MI 48092-2534
(586) 261-2266
(586) 582-9570
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
5301008786
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2043619
PK
—
Enumeration date
01/29/2008
Last updated
07/15/2013
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